Figure 1. The human pancreas.  (A) View of the pancreas showing clusters of acinar cells (i.e., acini), islet cells (i.e. islets), and pancreatic ducts. (B) An enlargement of a secretory region of the pancreas.  Acini secrete digestive enzymes into the small intestine, islets secrete the hormones insulin and glucagon into the bloodstream to regulate blood glucose concentration, and duct cells secrete bicarbonate to regulate small intestine acidity

 

Pancreas: Function

The pancreas is a small organ, approximately six inches long, located in the upper abdomen, and adjacent to the small intestine. It lies toward your back.  Because it is so deep within your body, doctors have difficulty diagnosing disease in the pancreas.  

 

The Pancreas

*  Completes the job of breaking down protein, carbohydrates, and fats using digestive juices of pancreas combined with juices from the intestines.

*  Secretes hormones that affect the level of sugar in the blood.

*  Produces chemicals that neutralize stomach acids that pass from the stomach into the small intestine by using substances in pancreatic juice.

*  Contains Islets of Langerhans, which are tiny groups of specialized cells that are scattered throughout the organ. 

 

 

 

 

 

Pancreatitis

*  Pancreatitis is a rare disease that is not fully understood. 

*  Pancreatitis is an inflammation of the pancreas which causes severe abdominal pain—may be either a brief or recurring problem. 

*  Mortality rate of patients with alcoholic pancreatitis is about 36% higher than that of the general population.

*  Annual incidence of acute pancreatitis in Native Americans is 4/100,000.

*  The link between alcohol abuse and pancreatic damage was first seen by N. Friedreich in 1878.

*  In the United States there is a wide variation in the percentage of pancreatitis cases that are attributed to alcoholism.  The statistics range from 5% to 90% depending on the population studied.  This disparity in the statistics is caused by the difficulty doctors have in identifying the cause of this disease.

*  Since only 5-10% of heavy drinkers develop pancreatitis, other factors may contribute to the onset of this disease; these factors may include genetics or nutritional factors.

 

 

 

 

 

There are two types of pancreatitis, acute and chronic.

 

 

Acute Pancreatitis:

Figure 2.  Acute pancreatitis.  Photo from Mosby’s dictionary 5th edition (Fletcher and McKee)

 

 

*  50,000-80,000 cases of acute pancreatitis occur in the United States each year.

*   Acute pancreatitis is when the pancreas suddenly becomes inflamed and then gets better. 

*   A person may have more than one attack but recover fully after each one.

*   The most common cause of acute pancreatitis in the United States is alcohol abuse. 

 

Causes:  Either alcohol abuse or gallstones, in some cases the cause is unknown but may actually be due to alcohol use in a person predisposed to pancreatic problems.

 

Symptoms:

*        Severe abdominal pain

*        Swollen, tender abdomen

*        Nausea

*        Vomiting

*        Fever

*        Sweating

*        Rapid pulse

*        Jaundice

 

 

20% of pancreatitis cases are very severe; the patient becomes dehydrated, with low blood pressure.  In the most severe cases, bleeding in the pancreas occurs which can lead to shock and sometimes death.

**It is important to seek medical attention as soon as possible.  Acute pancreatitis can be fatal**

 
Treatment:  Treatment depends on how bad the inflammation is.  Unless there are complications, the condition usually gets better on its own after a few days.

 

For the patient’s relief:

*  Fluids are injected by vein to restore blood volume.

*  Kidneys and lungs may be treated to prevent failure of those organs.

*  Antibiotics may be given if there is an infection.

*  Surgery may be needed if complications such as infection cysts or bleeding occurs.

*  Medication may be prescribed to reduce production of pancreatic juices.

*  Painkillers may be given.

 

 

Chronic Pancreatitis:

Figure 3. Chronic pancreatitis, scarring and calcification(calcium deposits) of pancreas.  Photo from Mosby’s Dictionary 5th edition (Fletcher and McKee).

 

*  Symptoms for chronic and acute pancreatitis may be similar making it difficult for doctors to differentiate between the two.

*  The pancreas becomes permanently damaged and unable to supply a sufficient amount of hormones and digestive juices.

*  First acute attack usually occurs after a binge-drinking episode.

*  Attacks become more frequent and the pain becomes more persistent and severe.

*  Pancreatic calcification occurs about 8-10 years after the first clinical presentation of the disease.

*  Chronic pancreatitis may develop after one acute attack especially if ducts become damaged.

*  This disease is more common in men than women, and typically the patient is diagnosed at 30-40 years of age.

*  Damage to the pancreas from drinking may have no symptoms for many years; then a patient may experience the sudden onset of pancreatitis.

 

 

 

 

*  Chronic pancreatitis causes three main kinds of problems: 

* Poor absorpbtion of food leading to weight loss

* Pain

* Diabetes, if islets of Langerhans are damaged.

 

Whether you are a chronic drinker or a binge drinker doesn’t seem to make a difference; the risk for chronic pancreatitis increases with time and amount of alcohol consumed.

*  Seventy percent of chronic pancreatitis cases are caused by chronic alcohol abuse.

*  Three to four standard drinks per day over a 10 year period is the average alcohol consumption seen in patients who develop clinically significant chronic pancreatitis.

*  Life expectancy of patients with advanced disease is typically shortened by 10-20 years. 

*  Chronic pancreatitis can progress even after you stop drinking alcohol.

*  There is such a difference between each person that it is not possible to say that even small amounts of alcohol are safe.

*  It has been suggested that the specific risk of pancreatic cancer among alcoholics may be limited to those alcoholics who develop chronic pancreatitis.  The relationship is not clear because of contributing factors such as malnutrition and smoking which are commonly associated with alcohol abuse.

 

Treatment: 

*  Painkillers

*  Enzyme tables to help digest food

*  Special diet

*  Surgery

 

AVOID ALCOHOL, ADHERE TO PRESCRIBED DIETS, AND TAKE PROPER MEDICATION TO HAVE FEWER AND MILDER ATTACKS OF PANCREATITIS

 

 

 

 

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